| National Provider Identifier [NPI]: | 1457500951 |
| Last Name Of The Provider | MAGGIO |
| First Name Of The Provider | DOMINIC |
| Middle Initial Of The Provider | |
| Credentials Of The Provider | FNP, BC |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 1208B VFW PKWY |
| Street Address 2 Of The Provider | STE 305 |
| City Of The Provider | WEST ROXBURY |
| Zip Code Of The Provider | 021324349 |
| State Code Of The Provider | MA |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Nurse Practitioner |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 16 |
| Number Of Services | 406 |
| Number Of Medicare Beneficiaries | 221 |
| Total Submitted Charge Amount | 17152.66 |
| Total Medicare Allowed Amount | 15829.32 |
| Total Medicare Payment Amount | 12366.77 |
| Total Medicare Standardized Payment Amount | 13701.89 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 6 |
| Number Of Drug Services | 134 |
| Number Of Medicare Beneficiaries With Drug Services | 124 |
| Total Drug Submitted ChargeAmount | 4132.66 |
| Total Drug Medicare AllowedAmount | 4132.66 |
| Total Drug Medicare PaymentAmount | 4049.98 |
| Total Drug Medicare Standardized Payment Amount | 4049.98 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 10 |
| Number Of Medical Services | 272 |
| Number Of Medicare Beneficiaries With Medical Services | 221 |
| Total Medical Submitted Charge Amount | 13020 |
| Total Medical Medicare Allowed Amount | 11696.66 |
| Total Medical Medicare Payment Amount | 8316.79 |
| Total Medical Medicare Standardized Payment Amount | 9651.91 |
| Average Age Of Beneficiaries | 72 |
| Number Of Beneficiaries Age Less65 | 21 |
| Number Of Beneficiaries Age 65 to 74 | 118 |
| Number Of Beneficiaries Age 75 to 84 | 65 |
| Number Of Beneficiaries Age Greater 84 | 17 |
| Number Of Female Beneficiaries | 139 |
| Number Of Male Beneficiaries | 82 |
| Number Of Non Hispanic White Beneficiaries | 208 |
| Number Of Black or African American Beneficiaries | |
| Number Of AsianPacific Islander Beneficiaries | 0 |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | 0 |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 204 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 17 |
| Percent Of With Atrial Fibrillation | 12 |
| Percent Of With Alzheimers Disease or Dementia | |
| Percent Of With Asthma | 7 |
| Percent Of With Cancer | 12 |
| Percent Of With Heart Failure | 8 |
| Percent Of With Chronic Kidney Disease | 14 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 10 |
| Percent Of With Depression | 13 |
| Percent Of With Diabetes | 19 |
| Percent Of With Hyperlipidemia | 47 |
| Percent Of With Hypertension | 57 |
| Percent Of With Ischemic Heart Disease | 20 |
| Percent Of With Osteoporosis | 8 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 33 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 0.8311 |